Recently a very bright, well educated woman was sharing pictures of her recent vacation to Italy.When she got to one picture, she looked confused for a moment and said “this was in Madrid”.Another woman suggested the scene in the picture looked like Milan.Greatly flustered, the first woman whined in despair that lately everything seems to slip out of her brain…she can not seem to remember anything.Her friend mentioned she is experiencing the same frustration.Both of these women are in perimenopause; one in her 40’s, the other in her early 50’s.

Perimenopause brings with it a notable decrease in concentration and memory.Women may forget names of people they have known for many years, where they have placed or stored items and even what they walked into a room to do or to get.This is not early onset of Alzheimer’s or late onset Attention Deficit Disorder!This is a normal part of perimenopause.Remember, the drastic hormonal changes that define perimenopause affect every cell in the body.

Fortunately, once perimenopause is over, concentration and memory improve.In the meantime, keep your notebooks, tablets and…oh what are they called?Oh yes, post-its handy!

Perimenopause is a time of drastically changes female hormones.Even before women notice changes in their menstrual cycles, the hormones, estrogen and progesterone are shifting.As perimenopause gets underway, as early as the late thirties, women begin having annovulatory cycles, cycles in which no ovulation takes place.Even without ovulating, she may still menstruate.

So, what does this have to do with our moods?It is during ovulation that progesterone is produced and released. When there is no ovulation, there is no production of progesterone. Progesterone is the ‘feel good’ hormone; it is the calming, soothing antidote to the very energizing (and sometimes stress-inducing) estrogen. So, with no ovulation, there is no progesterone, leaving women without one of their most calming hormones. This may result in women feeling stressed, high-strung or very much on edge.

Simultaneously, estrogen levels are vacillating wildly.In a given day, estrogen levels may be high and low.Estrogen also influences mood by increasing anxiety and decreasing patience and tolerance.

Changes in the production of these hormones do not follow a linear pattern. A woman may have months of normal cycles followed by a stretch of irregular cycles. There may be cycles in which she does ovulate followed by any number in which she does not. This is the very unpredictable nature of the perimenopausal transition and why women often feel they are on emotional rollercoasters.

When women enter their late 30’s or early 40’s they begin to experience hormonal changes that are the start of perimenopause. Perimenopause can last as many as 10 years, ending in menopause, which is the end of a woman’s reproductive years. Perimenopause initiates many changes. Some of these changes are physiological while others are psychological.

The problem for teens is that during this transition, moms may become emotionally unpredictable and irrational. This will not be an everyday occurrence. On some days she may be her “normal” self, while on other days her variable mood make make her seem like a stranger. The unpredictable nature of their mothers’ mood swings can make life very difficult and upsetting for the kids. This is especially the case when they cannot predict what will set off a screaming or crying episode in their mothers.

How can teenagers determine if their mom is in perimenopause? Looking for the following behaviors make make it easier to determine:

-Is she unusually moody, irritable or explosive?

-Are her reactions to minor events out of proportion?

-Is she weepy and emotional?

-Does she seem irrational…maybe even surprised at herself at times?

-Is she complaining about not sleeping well?

-Is she unusually forgetful?

-Is she tired all of the time…even when she appears to be sleeping normally?

-Is she having trouble sleeping?

-Is she doing bizarre things such as putting her keys in the refrigerator or forgetting to turn off the stove?

All of these behaviors are typical symptoms of perimenopause. Teens will be able to understand and relate to their mothers’ hormonal changes if they can remember their own erratic and sometimes irrational behaviors that they expressed when they went through puberty, also a time of tremendous hormonal change.

The important thing to remember is that when mom is experiencing the symptoms of perimenopause, even though she may appear to be angry with you, it is often not about you. She may burst into tears or explode in a rage over seemingly nothing. Even though it may appear that she is going crazy, these mood swings are a normal part of perimenopause, and will subside as she progresses through it.

When women do not understand what is happening to them hormonally, it is even more difficult to control the emotional highs and lows. Understanding perimenopause will help you find ways to cope with mom’s behavior…and maybe even enable you to help her through this difficult time.

Perimenopause, the 2 to 10 years preceding the cessation of menses, challenges forty to fifty year old women with the most turbulent hormonal changes since puberty.Such hormonal changes have an enormous impact, not only on her body and how it functions, but on her emotional state, as well.

Far too many women think of events related to menopause as being a concern only for those in their middle to late forties or early fifties.More enlightened women, who are familiar with ‘perimenopause’ too often think of it only in terms of hot flashes, night sweats, menstrual changes and some occasional mood swings.The majority of women, including those who are very well informed, are frequently shocked to learn how global the effect hormonal changes can make on depression, anxiety and overall life satisfaction.Even more important, are the interactive effects of how life challenges and hormonal events can combine to create additional misery, not just for women, themselves, but for their loved ones.

Perimenopause Facts:

-There are currently 59 ½ million women in the United States in the perimenopausal period between the ages of 39 and 53.

– Typically, perimenopause begins when a woman is in her forties, but may begin as early as the mid-thirties.

-The average age for menopause occurs at 51.3 years.

The mechanics of perimenopause are changes in the regular cycling of a woman’s hormones that she has been accustomed to since puberty. An irregular pattern of hormonal fluctuations, beginning with a significant rise in levels of estrogen and ending with a gradual overall decrease in estrogen and progesterone is activated.The most troublesome aspect of this change is that the decrease in hormones is neither linear nor predictable.It is the erratic rise and fall of the hormones throughout perimenopause that creates physiological and emotional havoc.

A large majority of these women will endure significant emotional and psychological upheaval during their changes — such as depression, anxiety, issues with sexuality and body image, insomnia, job dissatisfaction, marital difficulties and frustration in other relationships-often leaving women with a diminished sense of contentment with life, in general.

Not all women experience perimenopause the same way.For some women, perimenopause is relatively uneventful, bringing change but not to a disruptive level. For other women, the strength of the perimenopausal changes can be of an intensity that brings significant distress. The good news is that the instability does stabilize over time.

Most women will pass through four psychological stages of perimenopause. I identify and define these as:

Stage I Perimenopausal Initiation

Stage II Emotional Disruption

Stage III Turbulence

Stage IV Quietude.

There is an increasing sense of internal distress and outward emotional unpredictability in Stages I through III.Stage IV, Quietude, is when emotional lability begins to level out-leaving women as calm or calmer than before they entered perimenopause.

Many women in the menopausal transition also experience changes in their thyroid functioning, resulting in a decrease in their thyroid hormone levels. This adds to the challenging hormonal effects on mood and energy since hypothyroidism (low thyroid function) creates many of the same depressive and mood changing effects as perimenopause.

The relationship between changing female hormone levels and the body’s requirement for thyroid hormone is important to understand. When women’s estrogen levels are high, their bodies require more thyroid hormone. Conversely, when women’s estrogen levels are low, their bodies require less thyroid hormone. In women with healthy, well-functioning thyroids, this is not a problem since the thyroid secrets the appropriate amount of thyroid hormone to fit the body’s requirements. When the thyroid is not adequately functioning, as is common in the 40s and 50s, problems are likely to arise.

As women progress through perimenopause, their estrogen levels are changing frequently and drastically. This places a huge demand on the thyroid to manage the appropriate levels of thyroid hormone. When the thyroid is ailing, the level of thyroid hormone will be inadequate for the needs of the body. A visit to the doctor, even when blood work is done, may yield misleading results. If at the hour of the visit, your estrogen levels dip, the thyroid hormone level may appear adequate even though the thyroid may be grossly inadequate for those times that estrogen levels are high. At that time, the thyroid will not be able to keep up with the demand. Unless your doctor is familiar with the changing hormonal levels during perimenopause and how that interacts with your thyroid, he or she will likely miss the source of your symptoms.

If this isn’t enough…simultaneous to these vast hormonal changes, the typical 40 to 50-something year old woman is coping with some hefty emotional events.These include: the loss of her fertility, changing sexuality, aging parents, the emptying of her nest and resulting significant changes in her perspective on herself, her spouse and her self-defined meaningfulness. She is vulnerable to suffering an identity crisis equivalent in magnitude to one experienced in the teenage years.In addition, she will likely have stressful and challenging financial struggles as she manages both college tuitions and preparation for retirement.She is in the process of developing an entire new self as she evolves and redefines herself both physiologically and psychologically.

While women struggle through this difficult transition, their loved ones are struggling, too.Husbands and children have even less of an understanding of what is going on than the women, themselves.A wonderful example of the frustrations that so many men experience is Frank, who was happily married for twenty eight years to his forty eight year-old wife.In the throes of hormonal and emotional changes, his wife was miserable and Frank was distraught. In a moment of utter helplessness, Frank implored‘help me to understand, Doc, I am just a laborer.I don’t know what’s happening to my wife’.

Because of the hardship suffered by the women and the hardship imposed on the loved ones of the women making this transition, it is important for the whole family to speak openly, share informational materials and find ways to mutually support one another.With this type of approach, rather than becoming a destructive force that strains a family’s strength and well being, a family can discover new strength and methods of mutual support.

Perimenopause is a time of drastically changing female hormones.Even before women notice changes in their menstrual cycles, the hormones, estrogen and progesterone are shifting.This is often why women do not realize they are in perimenopause.Their menstrual cycles may appear as normal and regular as always, but behind the scenes, hormonal changes are underway.Most women do not know that even though they are menstruating, they may not be ovulating, throwing their hormones, and subsequently their moods, out of balance.

So, what does the onset of perimenopause have to do with our moods?

Estrogen and progesterone are the primary female hormones that undergo major shifts with the onset of perimenopause.These hormones, while responsible for female sex characteristics (the female body and procreation), are also highly influential in our moods.They affect our feelings of calm, anxiety, nurturing, romance and productivity.We can see that when the hormones shift, so will women’s moods.

As we will learn in Part II, it is during ovulation that calming progesterone is produced and released. With ovulation being so unpredictable, women’s moods are vulnerable to unpleasant shifts.Meanwhile, estrogen levels are vacillating wildly.In a given day, estrogen levels may be high and low… a number of times. Vacillating estrogen levels are notorious for increasing anxiety and decreasing patience and tolerance.Declining estrogen levels are influential in reducing the desire to nuture, in making women feel less driven and productive and disrupting replenishing sleep.

This is the very unpredictable nature of the perimenopausal transition and why women often feel they are on emotional rollercoasters.

Are you a woman in your late 30s to early 50s feeling depressed, anxious and generally “not yourself”? Have you been to your doctor or therapist only to leave frustrated because the reason can’t be pinned down? Do you sometimes feel fine and hours or days later feel miserable? There are many hormonal changes interacting in your body during this time of life that many doctors and therapists are unaware of.

Women in the age range from late 30s to early 50s are typically in perimenopause. This is a period of drastically changing hormones. In many women, it is not just the female hormones-estrogen and progesterone- that are changing. Many women in the menopausal transition experience changes in their thyroid functioning creating a decrease in their thyroid hormone levels. All of these hormones have an effect on mood and energy.

What many doctors miss is the relationship between changing female hormone levels and the body’s requirement for thyroid hormone. When women’s estrogen levels are high, their bodies require more thyroid hormone. Conversely, when women’s estrogen levels are low, their bodies require less thyroid hormone. In women with healthy, well-functioning thyroids, this is not a problem since the thyroid secrets the appropriate amount of thyroid hormone to fit the body’s requirements. When the thyroid is not adequately functioning, as is common in the 40s and 50s, problems are likely to arise.

As women progress through perimenopause, their estrogen levels are changing frequently and drastically. This places a huge demand on the thyroid to manage the appropriate levels of thyroid hormone. When the thyroid is ailing, the level of thyroid hormone will be inadequate for the needs of the body. A visit to the doctor, even when blood work is done, may yield misleading results. If at the hour of the visit, your estrogen levels dip, the thyroid hormone level may appear adequate even though the thyroid may be grossly inadequate for those times that estrogen levels are high. At that time, the thyroid will not be able to keep up with the demand. Unless your doctor is familiar with the changing hormonal levels during perimenopause and how that interacts with your thyroid, they may miss the source of your symptoms.

Checking the blood levels of thyroid hormone several times will give a better indication of what is really going on in your body. Doctors also need to carefully attend to the symptoms and feelings a woman is experiencing, especially if they are in this age bracket. There are many helpful remedies, so women should pursue finding the right health professional to get the support they deserve.